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Barriers to participation in a phase II cardiac
rehabilitation programme
YMW Mak, WK Chan, CSS Yue
Division of Cardiology, Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong
OBJECTIVES To identify barriers to participation
in a phase II cardiac rehabilitation programme and measures that
may enhance participation.
DESIGN. Prospective study.
SETTING. Regional hospital, Hong Kong.
PATIENTS. Cardiac patients recruited for a phase
I cardiac rehabilitation programme from July 2002 to January 2003.
MAIN OUTCOME MEASURES. Reasons for not participating
in a phase II cardiac rehabilitation programme.
RESULTS. Of the 193 patients recruited for a phase
I cardiac rehabilitation programme, 152 (79%) patients, with a mean
age of 70.3 years (standard deviation, 11.9 years), did not proceed
to phase II programme. Eleven (7%) deaths occurred before commencement
of phase II and 74 (49%) patients were considered physically unfit.
Reasons for the latter included fractures, pain, or degenerative
changes in the lower limbs (24%), and co-morbidities such as cerebrovascular
accident (19%), chronic renal failure (11%), congestive heart failure
(9%), and unstable angina (8%). Phase II rehabilitation was postponed until after completion of
scheduled cardiac interventions in 13% of patients. Failure of physicians
to arrange the pre-phase II exercise stress test as per protocol
was reported in 7% of patients. Other reasons were reported: work
or time conflicts (16%), non-compliance with cardiac treatment (5%),
financial constraints (4%), self-exercise (3%), fear after exercise stress
testing (3%), and patients returning to their original cardiologists
for treatment (3%).
CONCLUSIONS. A significant (79%) proportion of patients
did not proceed to a phase II cardiac rehabilitation programme for
a variety of reasons. These included physical unfitness, work or
time conflicts, and need to attend scheduled cardiac interventions.
Further studies are required to determine how to overcome obstacles
to cardiac rehabilitation.
Hong Kong Med J 2005;11:472-5
Key words: Cardiovascular diseases; Motivation; Patient dropouts; Patient participation
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